Enhanced descriptions from Syndetics:

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder.

Table of contents provided by Syndetics

• About the authors (p. xvii)
• Introduction (p. xix)
• Aims (p. xix)
• Organization of manual (p. xx)
• Core component of treatment (p. xxi)
• Who is this manual for? (p. xxii)
• The authors (p. xxiii)
• Chapter 1 Epidemiological and etiological research on borderline personality disorder (p. 1)
• Definition of the problem (p. 1)
• Diagnostic procedures (p. 2)
• Thresholds for diagnosis (p. 2)
• Epidemiology (p. 3)
• Clinical picture (p. 3)
• Phenomenological picture (p. 3)
• Functional impairment (p. 4)
• Psychodynamic picture (p. 5)
• BPO (p. 5)
• Defence mechanisms (p. 5)
• Object relations (p. 5)
• Co-morbidity (p. 7)
• Dimensional models of BPD (p. 8)
• The natural history of BPD (p. 9)
• The stability of the diagnosis over time (p. 9)
• The course of BPD (p. 10)
• Studies of mechanisms and aetiological factors (p. 12)
• Biological considerations (p. 12)
• Biological markers (p. 12)
• Genetic studies (p. 12)
• Neurotransmitter abnormality (p. 14)
• Candidate genes (p. 14)
• Cortical localization (p. 15)
• Attention and self-control (p. 18)
• Conclusion (p. 19)
• Psychosocial influences (p. 19)
• Theoretical considerations (p. 19)
• Parenting (p. 21)
• Parental separation or loss (p. 21)
• Family history (p. 21)
• Abnormal parenting attitudes (p. 22)
• Childhood trauma and maltreatment (p. 23)
• Models of psychosocial aetiology based on neglect and trauma (p. 26)
• The PTSD model (p. 26)
• The stress-diathesis model (p. 27)
• A multiple pathway model (p. 28)
• Biological pathways of the impact of extreme stress (p. 29)
• Childhood trauma as a risk factor for adverse brain development (p. 29)
• Serotonin system (p. 30)
• Endogenous opiate system (p. 30)
• HPA axis (p. 30)
• Anterior cingulate dysfunction (p. 31)
• Psychological pathways linking BPD to the impact of extreme stress: the role of affect dysregulation (p. 32)
• Attachment and BPD (p. 34)
• Theoretical considerations (p. 34)
• Empirical studies using the AAI (p. 35)
• Empirical studies using self-report measures of attachment (p. 35)
• Summary of empirical data (p. 36)
• Problems with a simple attachment model (p. 37)
• Conclusions (p. 37)
• Chapter 2 Therapy research and outcome (p. 39)
• Psychological treatments (p. 40)
• Psychoanalytic psychotherapy (p. 40)
• Empirical evidence for mentalization-based psychoanalytic treatment (p. 43)
• Results (p. 44)
• Cognitive analytic therapy (p. 46)
• Cognitive therapy (p. 46)
• Dialectical behaviour therapy (DBT) (p. 47)
• Therapeutic community treatments (p. 49)
• Drug treatments (p. 50)
• Antipsychotic drugs (p. 51)
• Antidepressant drugs (p. 51)
• Mood stabilizers (p. 51)
• Problems of outcome research (p. 52)
• Randomization and personality disorder (p. 52)
• Chapter 3 Mentalization-based understanding of borderline personality disorder (p. 55)
• The developmental roots of borderline personality disorder (p. 55)
• The relevance of the attachment theory perspective (p. 56)
• Optimal self-development in a secure attachment context (p. 57)
• Early stages of self-development (p. 59)
• The infant's sensitivity to social contingency (p. 59)
• The teleological stance (p. 61)
• The self as an intentional and representational agent (p. 62)
• Parental mirroring and the development of mental state concepts (p. 64)
• Psychic equivalence and the pretend mode (p. 68)
• Mentalization (p. 70)
• Reflective function and attachment (p. 75)
• Neurological basis of mentalization (p. 79)
• The impact of an insecure base (p. 82)
• The failure of mirroring (p. 82)
• Lack of playfulness (p. 83)
• Enfeebled affect representation and attentional control (p. 85)
• Disorganization of attachment (p. 87)
• Establishment of the 'alien self' (p. 88)
• Controlling IWM (p. 90)
• The impact of attachment trauma (p. 91)
• Failure of mentalization (p. 92)
• Changes to the arousal 'switch' (p. 94)
• Psychic equivalence, shame, and the teleological stance (p. 96)
• Failure of mentalization and the exposure of the 'alien self' (p. 97)
• Interpersonal relating and the transference (p. 99)
• Self-harm (p. 100)
• Suicide (p. 101)
• Impulsive acts of violence (p. 101)
• Clinical illustration (p. 103)
• Remembering trauma (p. 104)
• Conclusion (p. 109)
• Chapter 4 Current models of treatment for borderline personality disorder (p. 111)
• Transference-focused psychotherapy (TFP) (p. 112)
• Evaluation (p. 117)
• Dialectical behaviour therapy (p. 119)
• Dialectics (p. 119)
• Emotional dysregulation (p. 121)
• Mentalization and mindfulness (p. 122)
• Practice (p. 124)
• Cognitive behavioural therapy (p. 126)
• Cognitive analytic therapy (CAT) (p. 129)
• Reciprocal roles (p. 129)
• Reformulation and interpretation (p. 130)
• Psychodynamic-interpersonal (p. 132)
• Therapeutic communities (p. 134)
• Other North American approaches (p. 135)
• Other European approaches (p. 139)
• Mentalization: The common theme in psychotherapeutic approaches to borderline personality disorder (p. 141)
• Conclusion (p. 144)
• Chapter 5 Treatment organization (p. 145)
• Introduction (p. 145)
• Service models (p. 145)
• One-team model (p. 146)
• Treatment context (p. 147)
• Treatment guidelines (p. 147)
• The treatment programmes (p. 148)
• Staff (p. 150)
• The selection of staff (p. 150)
• Characteristics of training (p. 152)
• The team (p. 152)
• The key worker or primary clinician (p. 153)
• The responsible medical officer (p. 154)
• Assessment (p. 156)
• Engagement in treatment (p. 158)
• Pathway to admission (p. 159)
• Provision of information (p. 159)
• Clarification of key problems, as identified by the patient (p. 160)
• Explanation of the underlying treatment approach and its relevance to the problems (p. 160)
• Information about individual and group therapy and how it can lead to change (p. 160)
• An outline of confidentiality (p. 161)
• Clarification of some basic rules (p. 161)
• Violence (p. 161)
• Drugs and alcohol (p. 161)
• Sexual relationships (p. 162)
• Stabilizing social aspects of care (p. 162)
• Assuring the possibility of contact with the patient (p. 162)
• Clear-agreed goals (p. 163)
• Defining and agreeing roles of mental health professionals and others involved in the care of the patient (p. 164)
• History taking (p. 165)
• Interpersonal behaviour and intimate relationships (p. 165)
• Previous treatments and their outcome (p. 166)
• Formation of relational and working alliance (p. 167)
• Empathy and validation (p. 167)
• Reliability and readiness to listen (p. 169)
• Dynamic formulation (p. 169)
• Example of formulation (p. 170)
• Expressive therapies (p. 172)
• General strategic recommendations (p. 173)
• Organization (p. 173)
• Specific recommendations (p. 173)
• Common problems (p. 174)
• Drop-outs (p. 174)
• In-patient care (p. 174)
• Supporting the team (p. 175)
• Team morale (p. 175)
• Supervision (p. 177)
• Care programme approach (p. 179)
• Adherence (p. 180)
• Conclusions (p. 181)
• Chapter 6 Transferable features of the MBT model (p. 183)
• Structure (p. 183)
• Principle (p. 183)
• Rationale (p. 184)
• Boundary violations (p. 184)
• Implementation (p. 186)
• Consistency, constancy, and coherence (p. 187)
• Principle (p. 187)
• Rationale (p. 187)
• Implementation (p. 188)
• Relationship focus (p. 189)
• Principle (p. 189)
• Rationale (p. 189)
• Implementation (p. 190)
• Flexibility (p. 191)
• Principle (p. 191)
• Rationale (p. 191)
• Implementation (p. 191)
• Intensity (p. 192)
• Principle (p. 192)
• Rationale (p. 193)
• Implementation (p. 194)
• Individual approach to care (p. 194)
• Principle (p. 194)
• Rationale (p. 194)
• Implementation (p. 195)
• Use of medication (p. 195)
• Principle (p. 195)
• Rationale (p. 196)
• Implementation (p. 196)
• Summary of guidelines for psychopharmacological treatment (p. 199)
• Integration of modalities of therapy (p. 200)
• Conclusions (p. 201)
• Chapter 7 Strategies of treatment (p. 203)
• Enhancing mentalization (p. 203)
• Bridging the gaps (p. 205)
• Transference (p. 207)
• Retaining mental closeness (p. 210)
• Countertransference (p. 211)
• Working with current mental states (p. 212)
• Bearing in mind the deficits (p. 214)
• Real relationships (p. 216)
• Working with memories (p. 217)
• Hyperactive mentalization and pretend mode (p. 218)
• Conclusions (p. 220)
• Chapter 8 Techniques of treatment (p. 221)
• Identification and appropriate expression of affect (p. 222)
• General principles (p. 222)
• Rationale (p. 222)
• General strategic recommendations for identification of affects (p. 222)
• Individual session (p. 222)
• Group psychotherapy (p. 223)
• Impulse control (p. 224)
• General principles (p. 224)
• Rationale (p. 224)
• General strategic recommendations for dealing with problems of impulse control (p. 225)
• Suicide attempts and self-harm (p. 225)
• Suicide (p. 228)
• Self-harm (p. 230)
• Individual therapy (p. 231)
• Group therapy (p. 232)
• Other challenging affect states (p. 233)
• General principles (p. 233)
• Rationale (p. 233)
• General strategic recommendations (p. 234)
• Aggression related to paranoid anxiety (p. 234)
• Individual session (p. 236)
• Group therapy (p. 237)
• Passive aggression (p. 238)
• Individual session (p. 238)
• Group therapy (p. 239)
• Envy (p. 240)
• Individual session (p. 240)
• Group therapy (p. 241)
• Idealization (p. 242)
• Individual session (p. 242)
• Group therapy (p. 243)
• Sexual attraction (p. 244)
• Individual session (p. 245)
• Group therapy (p. 246)
• Hate and contempt (p. 247)
• Individual session (p. 248)
• Group therapy (p. 249)
• Love and attachment (p. 250)
• Individual session (p. 250)
• Group therapy (p. 251)
• Establishment of stable representational systems (p. 252)
• General principles (p. 252)
• Rationale (p. 252)
• General strategic recommendations (p. 253)
• Individual and group sessions (p. 253)
• Identifying primary beliefs and linking them to affects (p. 254)
• Identifying and understanding second-order belief states (p. 256)
• Exploring wishes, hopes, fears, and other motivational states (p. 257)
• Individual therapy (p. 258)
• Group therapy (p. 259)
• Formation of a coherent sense of self (p. 260)
• General principles (p. 260)
• Rationale (p. 260)
• General strategic recommendations (p. 261)
• Individual therapy (p. 261)
• Group therapy (p. 262)
• Development of a capacity to form secure relationships (p. 263)
• General principles (p. 263)
• Rationale (p. 263)
• General strategic recommendations (p. 265)
• Individual therapy (p. 265)
• Group therapy (p. 266)
• Conclusions (p. 267)
• Chapter 9 Implementation pathway (p. 269)
• Step 1 Consider the context in which you work, identify your skills and how you practice, and audit your resources (p. 270)
• Context (p. 270)
• Skills (p. 271)
• Audit of resources (p. 272)
• Step 2 Apply organizational principles (p. 272)
• Structure (p. 273)
• Clarity (p. 274)
• Consistency (p. 274)
• Relationship focus (p. 275)
• Intensity (p. 276)
• Medication (p. 277)
• Step 3 Modify the aims and techniques of your current practice (p. 278)
• Identify iatrogenic aspects of current practice (p. 278)
• Increase mentalization skill set incrementally to replace current iatrogenic techniques (p. 279)
• Step 4 Implement procedures for dealing with challenging behaviours (p. 281)
• Step 5 Constantly evaluate your practice (p. 281)
• Therapy adherence (p. 281)
• Systemic adherence (p. 282)
• Patient experience of treatment (p. 282)
• Appendix 1 Suicide and self-harm inventory (p. 287)
• Appendix 2 Training materials (p. 301)
• Appendix 3 Crisis plan (p. 313)
• Appendix 4 Rating of MBT adherence and competence (p. 315)
• Appendix 5 Text of intensive out-patient programme (IOP) leaflet (p. 319)
• Appendix 6 Admission feedback questionnaire (p. 321)
• References (p. 323)
• Index (p. 373)

Author notes provided by Syndetics